Mental Health Delivery System Research Articles

Addressing Systemic Racism in Mental Health Care

Systemic racism is a public health crisis that needs to be urgently and effectively addressed. Historical racism, contemporary biases, and prejudicial attitudes have persistently affected and damaged the mental health of people of color (POC) throughout the world. Although the 2021 apology from American Psychological Association (APA) acknowledged the profession’s contribution to racism, much more work needs to be done to rectify and address past and current harm. A comprehensive, actionable, and concrete plan is needed to catalyze change. Adopting a socioecological approach can help tackle the multiple levels in which discrimination and unequal treatment take place. This necessitates more than just addressing the social determinants of illness, but also transforming the cultural competence of providers, organizations, and the mental health delivery system. Key to improving outcomes for POC domestically and abroad is increasing the affordability and access to care, diversifying and improving the cultural competence of the mental health workforce, and developing culturally adapted and effective care tailored to meet the culture-specific needs of diverse communities. Progress can only happen through proactive action and utilization of an anti-racist stance that commits significant financial and scientific resources to promote institutional, structural, systemic, and policy changes.

Outcome of capacity building in mental health for well-being volunteers.

Volunteering is any activity in which time is given to assist another individual, group, or organization. It assists people who want to get involved in philanthropic programs that help volunteers develop awareness and lead healthier personal and social lives. Several volunteers have received specialized training in the fields in which they volunteer, such as health, mental health, education, or emergency rescue. Volunteers are rendering intervention in different areas in mental health. They are providing psychosocial support to the individuals, groups, community, promoting mental health through conducting various mental health awareness programs in the community. There is a growing concern about mental health in India due to the inaccessibility of services. The National Institute of Mental Health and Neuro Sciences (NIMHANS) being a premier institute for mental health, is devising innovative approaches to mental health care to reach the unreachable. One such initiative was to build the capacity of volunteers in the community who are interested in working for the cause of mental health. The objective of this study was to evaluate the outcome of the well-being volunteer program. This study used a descriptive cross-sectional research design, wherein all the 136 trained well-being volunteers (WBVs) were included as the study sample. The data was collected from the volunteers who attended the WBV program, which was initiated by NIMHANS Centre for Well-being (NCWB) and the Department of Psychiatric Social Work NIMHANS. A questionnaire on the outcome of the Well Being Volunteers program was developed for the study, and the Volunteer Motivation Inventory scale was used to collect the data from the WBVs. SPSS software was used to analyze the data. Ethical clearance was sought from the Institute Ethics Committee of NIMHANS. The WBV program enhanced volunteers' knowledge of mental health and benefited the volunteers in their personal and social life. They were also able to implement a satisfactory level of mental health-related volunteer activities in the community. Results of present study and the available literature suggest that engaging in voluntary services improves mental health knowledge. WBV program has provided opportunity to Volunteers to participate in mental health delivery system at different levels.

Towards a better understanding of mental health care delivery systems: From stories to system components

ABSTRACT The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed.

Mental health among first-generation college students: Findings from the national Healthy Minds Study, 2018-2021.

A mounting body of evidence reveals that college mental health outcomes are worsening over time. That said, little is known about the mental health needs of the nearly eight million first-generation students in U.S. postsecondary education. The present study uses population-level data from the national Healthy Minds Study to compare prevalence of mental health symptoms and use of services for first-generation and continuing-generation students from 2018-2021. The sample includes 192,202 students at 277 campuses, with 17.3% being first-generation. Findings reveal a high prevalence of mental health symptoms among both first-generation and continuing-generation students. Controlling for symptoms, FG students had significantly lower rates of mental health service use. Just 32.8% of first-generation students with symptoms received therapy in the past year, relative to 42.8% among continuing-generation students, and this disparity widened during the COVID-19 pandemic. Findings have important implications for the design and implementation of higher education policies, mental health delivery systems, college persistence and retention initiatives, and public health efforts in school settings.

A Study on Social Integration of the Mentally Disabled through Mental Health Delivery System Reform

이 연구는 정신장애인의 사회통합에 어떤 요인들이 영향을 미치고 있고, 그에 따라 지역사회 정신건강전달체계의 한계점과 정신건강증진시설의 역할을 재정립하여 정신장애인의 사회통합 증진방안을 제시하는 데 목적을 두고 있다. 이를 위해 정신의학 전문가, 정신건강전문요원, 가족 및 당사자, 지방자치단체 전문가 17명을 대상으로 델파이 조사를 실시하고 질적 자료분석을 하였다. 연구의 주요 결과를 정리하면 첫째, 정신장애인의 사회통합을 저해하는 요인으로는 정부의 사회통합 인프라 구축을 위한 재정투자 부족 문제가 가장 크게 주목받았다. 둘째, 정신장애인의 사회통합을 촉진하는 요인으로는 정부의 정신건강증진사업 수행 의지와 투자 확대 그리고 다양한 복지서비스를 결합한 사회복귀시설의 확충으로 압축되었다. 셋째, 현재 정신건강전달체계의 구조적 한계와 문제점으로 전문가들은 다양한 종류의 정신재활시설의 다양성 부족과 지역편차가 큰 정신건강 관련 예산문제를 중요하게생각하고 있었다. 넷째, 정신장애인의 사회통합증진을 위해 필요한 정신건강증진시설의 역할에 대해서 전문가들은 지역사회 기반 집중사례관리의 확대와 주거복지지원 기능을 갖춘 시설기능 강화를 중요하게 생각하는 것으로나타났다. 이에 따라, 본 연구에서는 정신장애인의 사회통합 증진을 위해 필요하다고 판단되는 정책적 우선순위에 따른 지역사회 정신건강전달체계의재편방안을 논의하고 제언하였다.

Drivers of County Engagement in Criminal Justice-Behavioral Health Initiatives.

Several large, county-level initiatives are underway to improve behavioral health care for justice-involved clients. Unfortunately, only about a quarter of counties participate in these efforts, leaving justice-involved populations at risk of poor mental health, substance use, and judicial outcomes. This study examined characteristics of 2,922 U.S. counties and county equivalents by whether they participated in these initiatives and found that crime and socioeconomic characteristics were not associated with participation. Participating counties had significantly more robust mental health and substance use care delivery systems. Nonparticipating counties may lack the expertise and basic delivery system prerequisites needed for participation in most national initiatives, further driving geographic disparities.

A Study on Women with Mental Illness Admitted to Halfway House and Recovery to Community (2016-2018)

Objectives: This study aims to understand the characteristics and actual conditions of female mentally ill patients using the halfway house and provide them with primary data to utilize the halfway house as an integrated approach within the mental health delivery system. Methods: This study’s subject is the case management record of 434 female mentally ill patients admitted to halfway house in Seoul from January 1, 2016, to December 31, 2018. Collected data were analyzed using SPSS Win 22.0 program. Results: The average age of subjects using halfway house was 44.2 years old, and 67.3% of the admission period was less than one month. 44.7% of the residential situation was in-home residence, and 41.0% of pre-admission job was the unemployed. and the most common type of social security was the medical benefit (65.7%). The most common onset of mental illness was in their twenties (44.5%), and the most common in diagnosing mental illness was schizophrenia spectrum disorder (89.4%). Those who did not receive the grade was 56.5% and grade of mental disorder was 43.5%. The most common reason for dismissal when improved symptoms (91.2%). Conclusions: This study reviews halfway houses’ role and function and proposes a follow-up study on applying programs operating within the community transformation facilities.

Methodology for Development of a Community Level Intervention Module for Physical Illness in Persons with Mental Illness (CLIPMI).

Background and Objectives:Medical illnesses seen in persons with psychiatric disorders are important but often ignored causes of increased morbidity and mortality. Hence, a community level intervention program addressing the issue is proposed.Materials and Methods:Patients with severe mental illnesses will be identified by a door-to-door survey and assessed for comorbid physical illnesses like anemia, hypertension, diabetes, and so on. They will then be randomized into two groups. The treatment as usual (TAU) group will not receive intervention from the trained community level workers, while the Intervention group will receive it.Results:The two groups will be compared for the prevalence and severity of comorbid physical illnesses. The expected outcome is compared to the TAU group, the intervention group will have a greater reduction in the morbidity due to physical illnesses and improved mental health.Conclusion:If successful, the module can be incorporated into the community level mental health delivery system of the District Mental Health Program (DMHP).

Relapse and Clinical Characteristics of Patients with Bipolar Disorders in Central Ethiopia: A Cross-Sectional Study.

Background Bipolar disorder is a severe mental illness and has huge morbidity and mortality. Relapse is a challenging treatment failure in patients with mental illness, especially in patients with bipolar which causes high economic and social burdens. In the mental health delivery system, relapse is common and can be defined as becoming ill again after apparent recovery and a worsening condition of psychiatric patients. Due to psychiatric patients that may stop medication on their own in contrary to the advice of mental health professionals, relapse of mood episodes, delayed remission, and residual symptoms usually leads to hospitalization, increased suicide risk, and/or impede psychosocial recover. Therefore, understanding the nature of relapse in patients in low-income countries helps to prevent recurrence and related health care expenses. Objective The objective of this study was to assess the prevalence and factors associated with relapse among patients with bipolar disorders in central Ethiopia. Method Facility-based cross-sectional study was conducted from May to June 2015 at Amanuel Mental Specialized Hospital. Relapse was calculated among 400 samples of people with bipolar disorder, and systematic random sampling was used to select the study participants. Oslo's social support scale and ASSIST were used to identify factors with relapse, and a binary and multivariable logistic regression analysis model was performed to control the confounding factors. Odds ratios (OR) with the corresponding 95% confidence interval (95% CI) were determined to evaluate the strength of association. Results The prevalence of relapse was 71% among patients with bipolar disorder. The longer morbidity (longer than 5 years) had a higher risk of relapse [adjusted odd ratio (AOR) = 3.91, 95% confidence interval (CI): 2.44 to 6.27], while good medication adherence found to be a protective factor for relapse [AOR = 0.39, 95% CI: 0.22 to 0.72]. Conclusion The prevalence of relapse was found pretty high among patients with bipolar disorders (71%). Working on treatment adherence and controlling the psychopathology is important to prevent relapse among bipolar patients.

REQUIREMENTS FOR DIAGRAMING IN THE DESIGN OF MENTAL HEALTH DELIVERY SERVICES

AbstractDelivering good quality mental health services remains a top priority in the English National Health Service (NHS). An approach to designing better delivery systems that takes into account the complexities of mental health services is highly desirable. This paper follows previous work that have sought to identify the key components of mental health delivery systems and explored the nature of the relationships between them. The paper presents the results of a qualitative thematic analysis of the requirements for diagrams as tools for describing and representing delivery systems in mental health.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

ADVANCING POLICY TO BUILD A BEHAVIORAL HEALTH WORKFORCE THAT ADDRESSES THE NEEDS OF OLDER ADULTS

California’s Mental Health Services Act has infused funding for workforce education and training into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This study draws on findings from a recent evaluation of how older adults are served by California’s public mental health delivery system, and a review of state planning documents and academic literature, to describe gaps and deficiencies in the workforce that serves older adults. While California has more than 80,000 licensed behavioral health professionals in a variety of disciplines, very few have specialized training in geriatrics. Across the U.S., there are fewer than 1,800 geriatric psychiatrists and only about 3% of medical students take any geriatrics electives during their training. Very few nurses (1%), psychologists (4%), or social workers (4%) have training in and/or specialize in geriatrics. Of additional concern in California is the lack of representation of ethnic and racial minorities, and rural/urban geographic disparities in the distribution of the behavioral health workforce. Recommendations for advancing policy change to improve the preparation and distribution of the geriatric behavioral workforce are presented to three distinct audiences: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.

California county embarks on new MH spending plan with unspent MHSA funds

Sacramento County officials in California have embarked on a new plan to address homelessness and to, among other things, expand existing programs for adults and children with mental health disorders. The mental health delivery and treatment system facilitated by unspent Mental Health Services Act (MHSA) funding, also known as Prop. 63, will focus on implementing programs under community services and supports (CSS), prevention and early intervention (PEI) and innovation programs.

Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap.

Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.

National Mental Health Survey of India, 2016 - Rationale, design and methods.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Fellowship Expands Behavioral Health Care Where Needed the Most

Fellowship Expands Behavioral Health Care Where Needed the Most

Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

BackgroundLow and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.MethodsA qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.ResultsThree main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.ConclusionHealth facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.

Psychiatric Residential Treatment Centers for Children and Adolescents: Modeling Variation in Facility Definition Type

A national picture of residential treatment centers (RTCs) for children is lacking and this situation may be complicated by differences between facilities in how RTCs are defined. This study uses data from a national survey of mental health facilities to supplement current knowledge about variation in the definition of RTCs nationwide. Descriptive analyses using 2012 National Mental Health Services Survey (N-MHSS) data were conducted on a standard definition of an RTC from the research literature and three different variations of it. Cohen’s h was calculated to assess whether differences in proportions were meaningful. While nearly two-thirds of RTCs that serve children define themselves following a standard definition in the research literature, nearly a quarter served adults, 9% did not require that residents have a diagnosis of serious emotional disturbance (SED), and a small proportion offered inpatient care in addition to residential care. Of the 9% of RTCs that did not require an SED diagnosis, the majority of these facilities were located in the West. This finding suggests that some of these RTCs may be wilderness programs, and it may also be an indicator of lack of RTC availability. Lack of consensus in the research literature and in the field regarding the definition of an RTC makes it difficult to compare different RTC study findings with each other. Development of a consensus definition of RTCs is a necessary first step to collecting comprehensive data and assessing the current state of this important component of the mental health delivery system.

Improving Ghana's mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government's commitment and the role of community mental health workers.

BackgroundThe scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries. There is growing interest in the effectiveness of task shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel.Given this background, the aim of our study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.ResultsAlmost all the psychiatrists and 23 (79.3 %) health policy directors were aware of the policy of the Government of Ghana to improve on the human resource base within mental health through a system of task-shifting. Overall, about half of the psychiatrists and 9 (31 %) health policy directors perceived there is some professional resistance to the implementation of the policy of task shifting. The majority of respondents were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders. The respondents identified that CMHWs usually perform two sets of roles, namely; officially assigned roles for which they have the requisite training and assumed roles for which they usually do not have the requisite training. The stakeholders identified multiple challenges associated with current task shifting arrangements within Ghana’s mental health delivery system, including inadequate training and supervision, poor awareness of the scope of their expertise on the part of the CMHWs.ConclusionPsychiatrists and health policy directors support the policy to expand mental health service coverage in Ghana through a system of task-shifting, despite their awareness of resistance from some professionals. It is important that the Government of Ghana upholds its commitment of expanding mental healthcare by maintaining and prioritizing its policy on task shifting and also providing the necessary resources to ensure its success.

Peer support services in the behavioral healthcare workforce: State of the field.

This article examines how the history and philosophy of peer support services has shaped current mental health and substance use service delivery systems. The growth of peer-run and recovery community organizations in the changing health care environment are discussed, including issues related to workforce development, funding, relevant policies, and opportunities for expansion. These initiatives are designed to increase access to recovery-promoting services. We conducted an environmental scan and analysis of peer support services within the behavioral health care field in the United States, with particular attention to initiatives of the Substance Abuse and Mental Health Services Administration. Published manuscripts, policy statements, and reports were reviewed. There is abundant and growing literature illustrating how peer support services have become an integral component of behavioral health care systems in many states. Peer support services have the potential to increase access to recovery-oriented services for people with mental and substance use disorders served by the public behavioral health care system. Numerous initiatives in various states are being undertaken to build this workforce. Workforce and financing challenges exist, yet opportunities, including among others those made possible by the Affordable Care Act, will continue to strengthen the peer support workforce within behavioral health service delivery systems. (PsycINFO Database Record